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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 192004352
Report Date: 01/07/2025
Date Signed: 01/07/2025 02:59:17 PM

Document Has Been Signed on 01/07/2025 02:59 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:GARCIA FAMILY CHILD CAREFACILITY NUMBER:
192004352
ADMINISTRATOR/
DIRECTOR:		GARCIA, HERMELINDAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 258-1314
CITY:LOS ANGELESSTATE: CAZIP CODE:
90042
CAPACITY: 12TOTAL ENROLLED CHILDREN: 9CENSUS: 2DATE:
01/07/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:39 AM
MET WITH:Hermelinda GarciaTIME VISIT/
INSPECTION COMPLETED:
03:10 PM
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On 01/07/2025, Licensing Program Analysts (LPAs) Mariah Aguirre and Monique Ayala conducted an unannounced Annual/Random inspection to the above facility. Upon arrival, LPAs disclosed the purpose of the inspection and met with Licensee Hermelinda Garcia who guided the LPAs on a tour of the facility. Adults in the home were discussed and most have criminal record clearance. One individual living in the home does not have fingerprint clearance and as a result, a type A deficiency is being given. There was 2 day care children present during today’s inspection. Licensee states that there are currently 9 children enrolled. The children's roster was reviewed and is current. Per licensee, the facility’s hours of operation are Monday to Sunday 6AM to 5AM. Emergency Disaster Plan, License, and Parents’ Rights were posted at the time of inspection. Disaster drill log was also available during today’s inspection, last disaster drill conducted was on 12/17/2024. LIC 126 was provided. Inspection was conducted in Spanish.

This is a single-story home which consists of 3 bedrooms and 2 bathrooms, living room, kitchen, outdoor laundry room, back yard, front yard, and side play area. Per licensee, areas used by the children include the living room, bedroom #1 (napping room/playroom), backyard and side play area. Areas off limits to children and parents include kitchen, bathroom #2, bedroom #2 and bedroom #3, outdoor laundry area, and front yard.



All areas identified on the facility sketch as accessible to children were inspected to ensure that they are clean and orderly with ventilation and heating for the safety of the children.
SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Mariah Aguirre
LICENSING EVALUATOR SIGNATURE: DATE: 01/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/07/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 11
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: GARCIA FAMILY CHILD CARE
FACILITY NUMBER: 192004352
VISIT DATE: 01/07/2025
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 Licensee has her cellphone as a working telephone in the home and is in contact with parents via call or text. LPAs observed age-appropriate toys, free of loose and sharp parts. LPAs observed electrical cover outlets all through the home. Detergents, cleaning compounds, medications, and other items which can pose a danger to children are inaccessible to children in care, and are kept in the outdoor laundry area, an off-limits area high and out of reach of children. The Licensee states that there are poisons in the home that are kept out of reach of children in the outdoor laundry area of the home. The Licensee does understand that poison must be locked. The Licensee was advised that inaccessibility of hazards must be constantly reassessed depending on the children in care. Personal Rights of children were observed by LPAs at time of inspection.

Per licensee, the children will have access to side play area. LPA observed side yard to have a gate at the bottom. If outdoor area not adequately fenced, provider must be with children at all times when outdoors. LPA advised Licensee that outdoor supervision is required at all times. LPA observed age-appropriate toys free of loose and sharp parts available for the children in the backyard and all trees, shrubs, and plants are maintained.

Per licensee, she provides all meals and snacks to children in care. LPAs observed one pet bird in a cage covered with a blanket in the living room. Per licensee, the bird is locked in the cage with a blanket covering the cage at all times children are present. Licensee confirms she has one firearm in the home. Per licensee the firearm in stored with the ammunition in a locked box and licensee states she no longer has the key. LPAs were unable to inspect the firearm to insure it was in compliance with Title 22 Regulations. While attempting to inspect the firearm, LPAs observed a mason jar of marijuana that was secured in a locked safe, making it inaccessible for children in care. Per licensee, the marijuana does not belong to her, and the licensee disposed of the marijuana right away. LPAs advised the licensee to keep all prescribed and non-prescribed drugs inaccessible to children at all times. Per Licensee, there are no bodies of water on the premises. LPAs observation did not see any bodies of water around the premises, but did observe a firearm at time of inspection.
SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Mariah Aguirre
LICENSING EVALUATOR SIGNATURE:

DATE: 01/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/07/2025
LIC809 (FAS) - (06/04)
Page: 2 of 11
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: GARCIA FAMILY CHILD CARE
FACILITY NUMBER: 192004352
VISIT DATE: 01/07/2025
NARRATIVE
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The valve on the required 2A10BC fire extinguisher has not been serviced since 09/19/2023 and is in need of servicing. Smoke and carbon monoxide detectors are in operable condition. Per Licensee, First Aid kit is kept in the hallway of the home, LPAs observed First Aid kit and was inventoried for necessary supplies. The Licensee has current Pediatric First Aid and CPR. Proof of immunization against influenza, pertussis, and measles was readily available during today’s inspection and are all current and up to date. The Licensee’s mandated reporter training has expired, and LPAs discussed the need to update the certification immediately.

—CPR Card valid until: 04/20/2026
—Fire Extinguisher was last serviced on: 09/19/2023
—Mandated Reporter AB1207 expired: 04/03/2026
—Children records and required licensing forms were discussed as well as mandated child abuse reporting and criminal record clearance requirement.

Based on LPAs observations of an infant in a crib with multiple blankets, toys, and a propped bottle feeding the baby and having an uncleared adult in the home, LPAs Mariah Aguirre and Monique Ayala informed licensee, Hermelinda Garcia that this report dated 01/07/2025 documents 2 Type A citations which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.

The following were discussed: Rooms that are off-limits need to be made inaccessible during operating hours.

SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Mariah Aguirre
LICENSING EVALUATOR SIGNATURE:

DATE: 01/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/07/2025
LIC809 (FAS) - (06/04)
Page: 3 of 11
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: GARCIA FAMILY CHILD CARE
FACILITY NUMBER: 192004352
VISIT DATE: 01/07/2025
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NO smoking, NO infant walkers, NO Johnny jumpers, NO saucer chairs, NO incline sleepers and any other item that falls into that category are permitted in the facility. Effective January 1, 2010, licensees of family childcare homes are required to ensure that at least one staff member with current training in pediatric first aid and pediatric CPR is on site at all times when children are present.

AB 1207: Beginning on January 1, 2018, this law requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. Volunteers are encouraged but not required to take the training. Website: http://www.mandatedreporterca.com/

Senate Bill 792: this bill, commencing September 1, 2016, prohibits a person from being employed or volunteering at a child care facility or family day care if he or she has not been immunized against influenza, pertussis and measles. LPA discussed the influenza waiver during the visit.

LPA reviewed and issued the LIC 311D - Forms/Records to Keep in Your Family Child Care Home. Mandatory Forms for the children’s files and staff files, requirements for fire drills, earthquake drills and documentation were discussed. Role and responsibilities of being a Mandated Reporter were reviewed. The Licensee was advised how to access forms and Regulations online at www.ccld.ca.gov. Licensee was made aware that it is his/her responsibility to know the regulations as well as anyone who assists in providing care.



To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.
SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Mariah Aguirre
LICENSING EVALUATOR SIGNATURE:

DATE: 01/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/07/2025
LIC809 (FAS) - (06/04)
Page: 4 of 11
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: GARCIA FAMILY CHILD CARE
FACILITY NUMBER: 192004352
VISIT DATE: 01/07/2025
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Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with licensee, Alejandra Nimri and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: https://www.ada.gov/resources/child-care-centers/.



MyChildCarePlan.org – Centers and Family Child Care Homes Licensee, was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the licensee confirmed that there are no Registered Sex Offenders living in the home and LPAs completed the RSO profile in FAS.

SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Mariah Aguirre
LICENSING EVALUATOR SIGNATURE:

DATE: 01/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/07/2025
LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: GARCIA FAMILY CHILD CARE
FACILITY NUMBER: 192004352
VISIT DATE: 01/07/2025
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Based on the LPA’s records reviews, the following deficiencies listed on the attached LIC 809D (deficiency page) are being cited in accordance with California Code of Regulations Title 22. Deficiencies that are being cited need to be cleared to protect the children’s health and safety. A notice of site visit was given and must remain posted for 30 days.

LPAs informed the licensee Hermelinda Garcia to provide a copy of this licensing report dated 01/07/2025 that documents any type A citations to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report, A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child’s file for verification.

Exit interview was conducted and a copy of the report was provided to Licensee, Hermelinda Garcia along with Appeal Rights.

SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Mariah Aguirre
LICENSING EVALUATOR SIGNATURE:

DATE: 01/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/07/2025
LIC809 (FAS) - (06/04)
Page: 6 of 11
Document Has Been Signed on 01/07/2025 02:59 PM - It Cannot Be Edited


Created By: Mariah Aguirre On 01/07/2025 at 01:01 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: GARCIA FAMILY CHILD CARE
FACILITY NUMBER: 192004352

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/07/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102417(g)(4)(C)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children. (C) Ammunition shall be stored and locked separately from firearms.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation and interview, the licensee did not comply with the section cited above as the licensee stated the firearm and ammunition are stored together and is unable to find the key for the lock box which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 01/17/2025
Plan of Correction
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Licensee will have a key made for the lock box, seperate the ammunition and firearm following Title 22 Regulations by POC date.
Type A
Section Cited
CCR
102425(b)
Infant Safe Sleep
(b) Cribs or play yards shall be free from all loose articles and objects.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above LPAs observed toys and blankets in the crib while the infant was eating which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 01/07/2025
Plan of Correction
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The licensee, immediately removed all of the toys and blankets from the crib.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Brandi VanOosten
LICENSING EVALUATOR NAME:Mariah Aguirre
LICENSING EVALUATOR SIGNATURE:
DATE: 01/07/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/07/2025


LIC809 (FAS) - (06/04)
Page: 7 of 11
Document Has Been Signed on 01/07/2025 02:59 PM - It Cannot Be Edited


Created By: Mariah Aguirre On 01/07/2025 at 01:01 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: GARCIA FAMILY CHILD CARE
FACILITY NUMBER: 192004352

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/07/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
HSC
1596.871(c)(1)(A)
Administration of Child Day Care Licensing
Subsequent to initial licensure, a person specified in subdivision (b) who is not exempt from fingerprinting shall obtain either a criminal record clearance or an exemption from disqualification, pursuant to subdivision(f) of this section or Section 1522.7, from the State Department of Social Services prior to employment, residence, or initial presence in the facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
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2
3
4
Based on record review and interview, the licensee did not comply with the section cited above licensee stated that her uncleared adult son lives in the home which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 01/17/2025
Plan of Correction
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Licensee will have uncleared adult son complete fingerprint clearance requirements.
Type A
Section Cited
CCR
102423(a)(2)
Personal Rights
(a) Each child receiving services from a family child care home shall have certain rights that shall not be waived or abridged by the licensee regardless of consent or authorization from the child's authorized representative. These rights include, but are not limited to, the following: (2) To receive safe, healthful, and comfortable accommodations, furnishings, and equipment.

This requirement is not met as evidenced by:
Deficient Practice Statement
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4
Based on observation, the licensee did not comply with the section cited above LPAs observed an infant in the crib eating with a bottle propped with a blanket which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 01/07/2025
Plan of Correction
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2
3
4
Licensee removed the blanket that was propping the bottle.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Brandi VanOosten
LICENSING EVALUATOR NAME:Mariah Aguirre
LICENSING EVALUATOR SIGNATURE:
DATE: 01/07/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/07/2025


LIC809 (FAS) - (06/04)
Page: 8 of 11
Document Has Been Signed on 01/07/2025 02:59 PM - It Cannot Be Edited


Created By: Mariah Aguirre On 01/07/2025 at 01:01 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: GARCIA FAMILY CHILD CARE
FACILITY NUMBER: 192004352

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/07/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(1)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (1) Fireplaces and open face heaters shall be screened to prevent access by children. The home shall contain a fire extinguisher and smoke detector device which meet standards established by the State Fire Marshall.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above in the fire extinguisher had no been serviced since 2023 which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/17/2025
Plan of Correction
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Licensee will service/replace the fire extinguisher by POC date.
Type B
Section Cited
CCR
102425(j)(1)
Infant Safe Sleep
The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall physically check on the infant every 15 minutes.

This requirement is not met as evidenced by:
Deficient Practice Statement
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2
3
4
Based on record review, the licensee did not comply with the section cited above in the licensee does not have a sleeping log for infants and states she was not aware of the requirement which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/09/2025
Plan of Correction
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2
3
4
Licensee will start implementing the sleeping log for infants 0-24 months and submit proof to LPA by POC date
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Brandi VanOosten
LICENSING EVALUATOR NAME:Mariah Aguirre
LICENSING EVALUATOR SIGNATURE:
DATE: 01/07/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/07/2025


LIC809 (FAS) - (06/04)
Page: 9 of 11
Document Has Been Signed on 01/07/2025 02:59 PM - It Cannot Be Edited


Created By: Mariah Aguirre On 01/07/2025 at 01:01 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: GARCIA FAMILY CHILD CARE
FACILITY NUMBER: 192004352

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/07/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102419(d)(1)
Admission Procedures and Authorized Representatives Rights
(d) At the time of acceptance of each child into care, the licensee shall provide the child's parent or authorized representative with a copy of the notice Family Child Care Home Notification of Parent's Rights, LIC 995A (8/06), the Caregiver Background Check Process, LIC 995E (6/05), and the Family child Care Consumer Awareness Information, LIC 9212 (10/05). (1) The licensee shall request the child's parent or authorized representative to sign and date the bottom portion of the notice form LIC 995A (8/06), which acknowledges that the parent or
authorized representative has received and read the LIC 995A. The bottom portion of this form
must be kept in the child’s file as proof that the parent or authorized representative has been
notified of his or her rights and received a copy of the Caregiver background Check Process, LIC
995E (6/05), and the Family Child Care Consumer Awareness Information, LIC 9212 (10/05).

This requirement is not met as evidenced by:
Deficient Practice Statement
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2
3
4
Based on record review, the licensee did not comply with the section cited above in 1 out of 5 children does not have the LIC995A in their file which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/17/2025
Plan of Correction
1
2
3
4
Licensee will have the LIC995A compelted and in the child's file by POC date.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Brandi VanOosten
LICENSING EVALUATOR NAME:Mariah Aguirre
LICENSING EVALUATOR SIGNATURE:
DATE: 01/07/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/07/2025


LIC809 (FAS) - (06/04)
Page: 10 of 11
Document Has Been Signed on 01/07/2025 02:59 PM - It Cannot Be Edited


Created By: Mariah Aguirre On 01/07/2025 at 01:01 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: GARCIA FAMILY CHILD CARE
FACILITY NUMBER: 192004352

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/07/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(m)(3)
Operation of A Family Child Care Home
(3) A file of affidavits signed by each parent with a child enrolled in the home. The affidavit shall state that the parent has been informed that the family child care home does not carry liability insurance or a bond according to standards established by the state.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above in 1 out 5 children does not have a signed LIC282 in their file which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/17/2025
Plan of Correction
1
2
3
4
Licensee will have the LIC282 compelted and in the child's file by POC date.
Type B
Section Cited
CCR
102425(c)
Infant Safe Sleep
An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 months of age the provider has in care and included in the infant's file at the facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above in 1 infant does not have an LIC9227 on file which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/10/2025
Plan of Correction
1
2
3
4
Licensee will have the completed LIC9227 in child file by POC date.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Brandi VanOosten
LICENSING EVALUATOR NAME:Mariah Aguirre
LICENSING EVALUATOR SIGNATURE:
DATE: 01/07/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/07/2025


LIC809 (FAS) - (06/04)
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